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Nur 943 OB > Exam 3 Pediatrics part 2 > Flashcards

Exam 3 Pediatrics part 2 Flashcards

(62 cards)

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1
Q

Herbal Remedies are associated with:

A

CV instability
Coagulation Disturbance
Prolonged Anesthesia
Immunosuppression

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2
Q

Which herbal supplements can prolong bleeding?

A 
Garlic, Ginsing, Ginko Biloba (3Gs)
and Feverfew (FG3?)
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3
Q

St. Johns Wort can do what?

A

Decrease Effectiveness of Drugs Metabolized by CYP3A4

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4
Q

Which Herbal supplement messes with immunosuppression?

A

Echinacea

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5
Q

Which herbal supplements POTENTIATES Sedative Effects of Anesthetic Agents?

A

Valerian Root and Kava

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6
Q

Pt has fever >38.4C, malaise, productive cough, wheezing, rhonchi and is scheduled for a non-emergent elective surgery. How would you proceed?

A

Postpone case 4-6 weeks

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7
Q

Pt has mild symptoms, nonproductive cough, sneezing and nasal congestion. Plans for nonemergent surg. How do you proceed.

A

Reginal or GA with mask can proceed.

Need ETT? - Wait 2-4 weeks

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8
Q

What drugs can help reduce airway secretions and hyperreactivity?

A

Anticholinergics and Beta Agonist

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9
Q

Check Hgb with these:

A

Risk of Potential for blood loss
Risk of Hemoglobinopathy
Former preterm infants and those <6mos old

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10
Q 
Pediatric Considerations that effect PK/PD
\_\_\_\_\_\_\_\_\_\_\_ composition
\_\_\_\_\_\_\_\_ of metabolic degradation pathways
\_\_\_\_\_\_\_\_\_ protein binding, 
Immaturity of \_\_\_\_\_\_\_\_barrier
Greater blood flow to \_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ in GFR
\_\_\_\_\_\_\_ FRC
\_\_\_\_\_ MV
Immature receptor responses
A 
Pediatric Considerations that effect PK/PD
Total body water (TBW) composition
Immaturity of metabolic degradation pathways
Reduced protein binding, 
Immaturity of blood-brain barrier
Greater blood flow to vessel-rich organs
Reductions in GFR
Smaller FRC
↑ MV
Immature receptor responses
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11
Q

Total Body Water % for Preterm, Full-term, and Adult

A

90%, 80%, 60%

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12
Q

Extracellular Fluid % for Preterm, Full-term, and Adult

A

50%, 40%, 20%

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13
Q

Intracellular Fluid % for Preterm, Full-term, and Adult

A

40%, 40%, 40%

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14
Q

Fat % by Weight for Preterm, Full-term, and Adult

A

3%, 12%, 18%

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15
Q

Muscle Mass % by Weight

A

15%, 20%, 50%

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16
Q

How to calculate Volume of Distribution

A

Divide dose of administered drug by plasma concentration.

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17
Q

Infants have a _____ Extracellular fluid and _____ TBW. This leads to _____ plasma concentration of water soluble drugs and _____ plasma concentration of lipid soluble drugs.

A

Larger, greater

lower plasma concentration (diluted) H2O-soluble drugs – higher dose; lipid-soluble has higher plasma concentration due to decreased fat & muscle

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18
Q

Infants will need a _____ dose of water soluble drug

A

Higher

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19
Q

Infants will need a ____ dose of lipid soluble drug

A

Lower

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20
Q

Infants have ______plasma proteins, which means

A

Reduced plasma proteins, so more free drug available

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21
Q

Proteins reach adult equivalence by ______

A

5-6 months

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22
Q

Protein binding is fully functional by _______

A

1 year old

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23
Q

What are Phase 1 reactions

A

3 enzyme reactions catalyzed by P450 System
Hydrolysis
Oxidative
Reduction

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24
Q

What are Phase 2 Reactions

A

Conjugation- couples drug with substrate for excretion

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25
Which Phase reaction is immature at birth?
Phase 2- Conjugation
26
Enzyme systems are present but reduced at birth, this ______ drug elimination half-lives
Increases
27
Major objectives to giving premeds to pediatrics
``` Allay Anxiety Block Autonomic (Vagal) Reflexes Reduce AW secretions Produce Amnesia Provide Prophylaxis against Pulmonary Aspiration of Gastric Contents Facilitate Induction of Anesthesia Provide Analgesia, if needed ```
28
What is the Rectal dose for Methohexital?
20-40mg/kg (10% solution)
29
Rectal dose for Midazolam
1mg/kg
30
Oral dose for Midazolam
0.25-0.75mg/kg
31
Nasal dose for Midazolam
0.2mg/kg
32
IM dose for Midazolam
0.1-0.15
33
Ketamine Oral Dose
3-6mg/kg
34
Nasal dose of Ketamine
3mg/kg
35
Rectal Dose of Ketamine
6-10mg/kg
36
IM dose of Ketamine
2-10mg/kg
37
IM dose of Morphine
0.1-0.2mg/kg
38
IM dose of Meperidine
1-2mg/kg
39
Oral Dose of Fentanyl
10-15mcg/kg
40
Nasal Dose of Sufenanil
1-2 or 1-3mcg/kg
41
Midazolam is ______-soluble
Water-soluble
42
Peak plasma concentrations are ____ after intranasal ____ after rectal _____ after oral
10min 16 min 53 min- Fucking 53 MINUTES!!!!
43
1mg/kg
What is the rectal dose for Midazolam?
44
What is the IV dose for Midazolam?
0.025-0.1mg/kg IV | or 25-100mcg/kg IV
45
0.25-0.75mg/kg
PO dose of Midazolam
46
0.2mg/kg
Intranasal dose of midazolam
47
0.025-0.1mg/kg
IV dose of midazolam
48
How long does midazolam last?
1/2-2hours
49
What are the advantages of midazolam
rapid uptake and elimination
50
IV dose for Morphine
0.05-0.1mg/kg for preop pain
51
Fentanyl IV dose
10-15mcg/kg, onset in 10 mins
52
Intranasal dose of Fentanyl
1-2mcg/kg, usually after induction
53
Sufentanil intranasal dose
1.5-3mcg/kg (premed)
54
Ketamine causes a dissociation of ____ from the ____system
cortex from the limbic
55
Disadvantages of Ketamine
Sialorrhea, Nystagmus, Psychological Reactions
56
Anticholinergics can
prevent bradycardia Minimize autonomic vagal effects Reduce secretions
57
S/E of Anticholinergics
Dry Mouth Skin Erythema Tachycardia Hyperthermia
58
Anticholinergics ______ and _____ crosses the BBB _______ does not
Atropine and Scopolamine crosses BBB | Glycopyrrolate does not cross the BBB
59
Acetaminophen dose for myringotomies
10-15mg/kg
60
Acetaminophen dos for T and A
Preop 40mg/kg + 20 mg rectally in 2 hours
61
Ofirmev 13 years + (>50kg)
1000mg/6 hours or 650mg/4 hours
62
Ofirmev 2y/o <50kg
15mg/kg/6h or 12.5 mg/4h

Nur 943 OB (11 decks)

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